Effectiveness of BNT162b2 Vaccine against Critical Covid-19 in Adolescents

Samantha M. Olson, Margaret M. Newhams, Natasha B. Halasa, Ashley M. Price, Julie A. Boom, Leila C. Sahni, Pia S. Pannaraj, Katherine Irby, Tracie C. Walker, Stephanie P. Schwartz, Aline B. Maddux, Elizabeth H. Mack, Tamara T. Bradford, Jennifer E. Schuster, Ryan A. Nofziger, Melissa A. Cameron, Kathleen Chiotos, Melissa L. Cullimore, Shira J. Gertz, Emily R. LevyMichele Kong, Natalie Z. Cvijanovich, Mary A. Staat, Satoshi Kamidani, Brandon M. Chatani, Samina S. Bhumbra, Katherine E. Bline, Mary G. Gaspers, Charlotte V. Hobbs, Sabrina M. Heidemann, Mia Maamari, Heidi R. Flori, Janet R. Hume, Matt S. Zinter, Kelly N. Michelson, Laura D. Zambrano, Angela P. Campbell, Manish M. Patel, Adrienne G. Randolph

Research output: Contribution to journalArticlepeer-review

132 Scopus citations


BACKGROUND The increasing incidence of pediatric hospitalizations associated with coronavirus disease 2019 (Covid-19) caused by the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States has offered an opportunity to assess the real-world effectiveness of the BNT162b2 messenger RNA vaccine in adolescents between 12 and 18 years of age. METHODS We used a case-control, test-negative design to assess vaccine effectiveness against Covid-19 resulting in hospitalization, admission to an intensive care unit (ICU), the use of life-supporting interventions (mechanical ventilation, vasopressors, and extracorporeal membrane oxygenation), or death. Between July 1 and October 25, 2021, we screened admission logs for eligible case patients with laboratory-confirmed Covid-19 at 31 hospitals in 23 states. We estimated vaccine effectiveness by comparing the odds of antecedent full vaccination (two doses of BNT162b2) in case patients as compared with two hospital-based control groups: patients who had Covid-19-like symptoms but negative results on testing for SARS-CoV-2 (test-negative) and patients who did not have Covid-19-like symptoms (syndrome-negative). RESULTS A total of 445 case patients and 777 controls were enrolled. Overall, 17 case patients (4%) and 282 controls (36%) had been fully vaccinated. Of the case patients, 180 (40%) were admitted to the ICU, and 127 (29%) required life support; only 2 patients in the ICU had been fully vaccinated. The overall effectiveness of the BNT162b2 vaccine against hospitalization for Covid-19 was 94% (95% confidence interval [CI], 90 to 96); the effectiveness was 95% (95% CI, 91 to 97) among test-negative controls and 94% (95% CI, 89 to 96) among syndrome-negative controls. The effectiveness was 98% against ICU admission and 98% against Covid-19 resulting in the receipt of life support. All 7 deaths occurred in patients who were unvaccinated. CONCLUSIONS Among hospitalized adolescent patients, two doses of the BNT162b2 vaccine were highly effective against Covid-19-related hospitalization and ICU admission or the receipt of life support.

Original languageEnglish (US)
Pages (from-to)713-723
Number of pages11
JournalNew England Journal of Medicine
Issue number8
StatePublished - Feb 24 2022

Bibliographical note

Funding Information:
The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Supported by the Centers for Disease Control and Prevention under a contract with Boston Children’s Hospital. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Publisher Copyright:
Copyright © 2022 Massachusetts Medical Society.


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